During a live interactive webcast today hosted by the Kaiser Family Foundation, an expert panel agreed that tuberculosis poses a grave global health threat and demands an innovative, multifaceted response—from new drugs to scaled-up treatment to better infection control.
The lively forum, available here, highlighted the need for an aggressive approach to the global tuberculosis epidemic just as the US government is putting the finishing touches on its five-year global tuberculosis strategy. But it’s far from clear the US will provide the leadership and resources needed.
Cheri Vincent, senior public health advisor in the Infectious Diseases Division, Bureau for Global Health, at USAID, said her agency is now mapping out its five-year TB strategy, working in conjunction with PEPFAR, the Department of Defense, and other agencies. One key objective, she said, is to halve TB prevalence by 2015 from 1990 levels. Another goal is to get at least 90,000 patients with multi-drug resistant TB on treatment, she said, noting that right now, very few MDR-TB patients are being treated in adherence with international guidelines.
“We also need to build on the health system platform and make sure we’re doing it in a cost effective and integrated approach,” Vincent said.
Christine Sizemore, Ph.D., chief of the Tuberculosis and other Mycobacterial Diseases Section in NIAID’s Division of Microbiology and Infectious Diseases, noted that in 1985, the research institute’s budget for TB was only $160,000 a year and the disease had fallen off the medical community’s agenda. It popped back up in the 1990s, when an outbreak of drug-resistant TB in the U.S. made scientists realize this was a continuing threat.
Now, she said, the National Institute of Allergy and Infectious Diseases has made a “fairly significant investment” in TB, spending about $140 million a year on TB related research. But, Sizemore said, “We need to start looking at the disease in a larger context.” She said discussions are underway to move toward what NIAID director Tony Fauci has called a “transformative” research agenda for TB. For more on Fauci’s vision, read this post.
Christine Lubinski, director of the IDSA/HIVMA Center for Global Health Policy, said while these steps are vital, the US government’s response still does not reflect the urgency of the epidemic. She noted that when Congress reauthorized the global AIDS initiative, known as PEPFAR, in 2008, lawmakers authorized $4 billion over five years for TB control, but decision-makers are not on track to fulfill that funding commitment.
In the last budget proposal from the White House, “we did not see … even remotely a down payment on that,” Lubinski said.
“We could paper this town with the reports” that have been done mapping out the need for a robust response to TB. “What we don’t have is the leadership and resources to make that a reality,” she said.
Dr. Robin Wood, director of the Desmond Tutu HIV Centre in Cape Town, described the scope of the TB epidemic in South Africa as nearly unprecedented, with some communities nearly 100 percent infected with TB. He said current strategies to combat the disease are woefully inadequate in places like South Africa, where the population is subject to a high pressure infection.
“We need the US to lead in the scientific approach and really transforming the approach” to combating this deadly scourge, said Dr. Robin Wood, a preeminent physician-scientist who has conducted cutting edge research on the deadly intersection of TB and HIV/AIDS in his home country.
“We’ve taken our eye off the ball and we’re looking at treating end-stage disease,” as opposed to taking a more proactive approach that looks at stemming the tide of new infections. “This is really an emergency that needs focus,” Wood said.
And while the search for new diagnostics and drugs is important, he said, the pursuit of a “magic bullet” cure should not eclipse more immediate and simpler solutions. “Surely we can use our existing technologies in a more rational way,” he said.